Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Blogger's Note: read paper for full details - ovarian cancer is considered high risk (Table 5)

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Recommendations
Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE...........

LIMITATIONS
These recommendations are based on data identified by a systematic
review of the literature. Some key questions are, as yet, unanswered.
The potential benefits and harms of thromboprophylaxis in patients
with cancer receiving chemotherapy in the outpatient setting and the
utility of risk assessment require additional research. Future thromboprophylaxis trials in outpatients receiving chemotherapy may benefit from the identification of high-risk groups in whom the balance of benefits and harms favors prophylaxis.